The Global Forum on Incontinence

The 7th biennial Global Forum on Incontinence (GFI) took place in Rome on the 17-18 April at the Sheraton Hotel and Conference Centre. Organised by Essity in collaboration with partners AGE Platform Europe, Eurocarers and IAPO, the conference brought together more than 300 people from across the world with an interest in incontinence and continence care. The theme of this year’s forum was ‘how to measure outcomes on the delivery of toileting and containment strategies to improve the provision and quality of services for people living with incontinence’.

Dr. Adrian Wagg, Chair of the GFI, began the first session by welcoming delegates and emphasised the importance of good continence care to people’s lives. He called for a ‘normalisation of conversations concerning incontinence’ in order to stimulate discussions and encourage people to access care. Wagg stressed that a major theme of this year’s conference was the initial management and assessment of care as a means to reduce the future burden for both patients and carers.

How big is the problem?

Former Chair Ian Milson, who is currently Head of the Women’s Hospital and Queen Silvia’s Children Hospital, sought to expose the prevalence of incontinence and the debilitating effect it can have; chronic incontinence affects between 4-8% of the global adult population. That’s some 400 million people worldwide, meaning ‘if incontinence was a country, it would be the third largest in the world’, said Milson.

Both Wagg and Milson spoke of the challenges of treating incontinence in an ageing population. A significant issue, given that by 2050 over 80s are projected to number roughly 379 million people globally – a more than five-fold increase on 2000 levels. With this will come a concomitant rise in the prevalence of incontinence, demand for care and pressure on services. Both, however, pointed to ‘primary care as the place to target’ when attempting to deal with incontinence, especially when considering that 50% of those suffering do not access care because of embarrassment or social stigma.

Milson’s exposure of incontinence’s prevalence worked to demonstrate how it still remains a ‘hidden condition’. Although affecting more people than asthma, COPD, Alzheimer’s, diabetes and stroke, incontinence does not receive the safe level of attention in policy or public dialogue. And because of its place as a common comorbidity it is often associated with a primary disease or “an inevitability of getting older”. Calls to debunk this “myth” were routinely made throughout the conference.

The role of nurses

The first day also saw Jennifer Skelly, Associate Professor in the School of Nursing at McMaster University in Canada, speaking about the role nurses play in the management and care of incontinence. In the 1990s, Skelly visited several continence care providers in the UK. She then took ideas she had gained from the trip back to Canada where she applied them in practice.

‘The UK was very different then,’ said Skelly. ‘Both countries have since evolved in different ways and the role of nurses has changed significantly. They are now far more active in care giving.’

Skelly argued that Canada had placed an emphasis on raising awareness and starting dialogue, which needs to be emulated at a global scale. She did, however, acknowledge that her views have changed over the years and in the face of changing circumstances. ‘Before I was more focused on making people dry and encouraging preventative care. I now recognised the role for products, as long as this is not seen as a permanent solution,’ she told Independent Nurse.

Working with a number of organisations, such as the International Continence Society, and by establishing continence care programmes at her university, Skelly wants to ‘evolve current measure into a long-term care solution’. She called for more help and resources to be provided to nurses so that they can be fully equipped and educated to deal with issues of incontinence.

Getting the funding right

Richard Humphries, senior fellow at the health think tank The King’s Fund and well-regarded national commentator on social care reform, tied the days talks together through a discussion of funding and reimbursement structures. Humphries called for more integrated commissioning models so that local health authorities in the UK become more willing to prescribe effective and tailored products, even when at a higher cost. This, he said, would bring greater benefits in terms of savings due to the future cost of care associated with inappropriate policy and product provision, which far outstrips proper procurement.

Given that half of incontinence sufferers live at home and that it is the second most common cause – behind dementia – for admittance to a care facility, Humphries urged delegates to ‘adopt the community and not the hospital as the place to treat incontinence’. He too stressed the challenges of an ageing population and the need to see community care as a way keep people out of hospitals, easing the pressure on hospital settings. Here, district and community nurses, as well as informal carers, can play a vital role in identifying and diagnosing incontinence early.

‘The balance of spending is wrong at the moment,’ Humphries said. ‘Not enough is being spent on prevention and community care. This short-term focus at the moment is not helpful. We need long-term solutions.’

To take home

Punctuating the talks were a number of powerful patient testimonies that brought the issue of incontinence home. Speakers such as Derick Fage, Elena Weber and Mario SEL all spoke passionately about the challenges they face from having, or caring for someone with, incontinence. Their experiences, coupled with calls to end the stigma and myths surrounding incontinence, created an enthusiastic buzz within the conference hall. Exchange of ideas and knowledge was widespread as many delegates sought to identify what area was best to focus on. The take home message was that nurses, in the home and community, are best placed to deliver effective and preventative that changes patients’ lives.

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